Clinical Transplantation (CLIN TRANSPLANT)

Publisher: Wiley

Journal description

Clinical Transplantation is primarily designed as a channel of communication for all those involved in the care of people who require or have had organ or tissue transplants including: kidney intestine liver pancreas heart heart valves lung bone marrow cornea skin bone and cartilage viable or stored. Interest is focused not only on the complete spectrum of present transplant operations but also those that are experimental or may become possible in future. Original articles are welcomed on all clinical and surgical aspects including: indications for and techniques of surgery; immunology and immunosuppression; patient preparation social ethical and psychological issues; complications short- and long-term results; artificial organs and the preservation and storage of organ and tissue. Full length papers and short communications are invited. Occasional clinical reviews are published as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. The journal is essential reading for surgeons of all major and subspecialities clinical immunologists; cryobiologists; hematologists; gastroenterologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists psychologists and research workers; in fact to all whose combined efforts will improve the prognosis of future transplant recipients.

Current impact factor: 1.52

Impact Factor Rankings

2016 Impact Factor Available summer 2017
2014 / 2015 Impact Factor 1.522
2013 Impact Factor 1.486
2012 Impact Factor 1.634
2011 Impact Factor 1.667
2010 Impact Factor 1.751
2009 Impact Factor 2.004
2008 Impact Factor 1.915
2007 Impact Factor 1.923
2006 Impact Factor 2.051
2005 Impact Factor 1.887
2004 Impact Factor 1.635
2003 Impact Factor 1.582
2002 Impact Factor 1.534
2001 Impact Factor 1.893
2000 Impact Factor 1.841
1999 Impact Factor 1.29
1998 Impact Factor 1.508
1997 Impact Factor 1.079
1996 Impact Factor 1.682
1995 Impact Factor 1.159
1994 Impact Factor 0.891
1993 Impact Factor 1.005
1992 Impact Factor 1.309

Impact factor over time

Impact factor

Additional details

5-year impact 1.58
Cited half-life 6.60
Immediacy index 0.18
Eigenfactor 0.01
Article influence 0.53
Website Clinical Transplantation website
Other titles Clinical transplantation (Online)
ISSN 0902-0063
OCLC 45884487
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details


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    • On author's personal website, institutional repositories, arXiv, AgEcon, PhilPapers, PubMed Central, RePEc or Social Science Research Network
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    • Must link to publisher version with set statement (see policy)
    • If OnlineOpen is available, BBSRC, EPSRC, MRC, NERC and STFC authors, may self-archive after 12 months
    • If OnlineOpen is available, AHRC and ESRC authors, may self-archive after 24 months
    • Publisher last contacted on 07/08/2014
    • This policy is an exception to the default policies of 'Wiley'
  • Classification

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Matrix metalloproteinases (MMP) are involved in the development of interstitial fibrosis and tubular atrophy (IF/TA) in renal disease. The synthesis of MMP is activated by the extracellular matrix metalloproteinases inducer protein (EMMPRIN). To analyze the role of EMMPRIN in IF/TA we retrospectively detected EMMPRIN expression in specimens of human renal allografts with various levels of IF/TA. Methods: Immunohistochemistry was performed to detect EMMPRIN expression. In a retrospective analysis a total cohort of 50 specimens was divided according to BANFF-classification into four subgroups (0-3): no, mild (≤ 25%), moderate (26-50%) or severe (> 50%) IF/TA. Among other parameters renal function was analyzed and compared to EMMPRIN expression. Results: In 24 of 38 biopsies we detected positive EMMPRIN staining. All nephrectomy (n=12) samples were negative for EMMPRIN. Positive staining in the biopsy samples was detectable on the basolateral side of tubular epithelial cells. EMMPRIN staining was negatively correlated with IF/TA (p<0.001). We found significant differences between the mean EMMPRIN expression in IF/TA groups 0 and 3 (p=0.021) and groups 1 and 3 (p=0.004). Furthermore we found significant correlations between EMMPRIN staining and renal function. Conclusion: Our data suggest that EMMPRIN is involved in the pathophysiology of IF/TA. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2015 · Clinical Transplantation
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    ABSTRACT: Although the pathogenic pathways leading to de novo immune hepatitis (IH) are not completely understood we have shown strong evidences of an anti-donor response against Glutathione S-transferase T1 (GSTT1), an antigen exclusively expressed in the donor liver. The first sign of this process is the production of GSTT1 antibodies that, in 25% of the cases, will precede de novo IH. Because the presence of the antibodies is not sufficient to trigger the disease we aimed to study GSTT1 IgG subclasses in a group of 18 liver transplant patients, 12 that developed de novo IH and 6 that remained free of disease. Surprisingly, the predominant subclasses were IgG1-GSTT 1 and IgG4-GSTT 1 . The presence of IgG4-expressing plasma cells was also investigated in 10 available liver biopsies. Six biopsies coinciding with diagnosis showed a mean value of 32.8 IgG4+ plasma cells/hpf vs 5.55 in patients without the disease. We have not found a distinctive GSTT1-IgG profile in patients with de novo IH but the ratio IgG1-GSTT 1 /IgG4-GSTT 1 in samples from close to the time of diagnosis seemed to be important. The novel finding of abundant IgG4-GSTT 1 in liver transplantation is intriguing but their possible role in pathogenesis of de novo IH remains unknown. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2015 · Clinical Transplantation
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    ABSTRACT: Background: The risk-benefit for utilizing cardio-pulmonary bypass (CPB) in lung transplantation (LTx) remains debatable. This study compares outcomes after LTx utilizing different CPB strategies- elective CPB vs. off-pump vs. off-pump with unplanned conversion to CPB. Methods: A total of 302 LTx performed over 7 years were divided into three groups: 'off-pump' group (n=86), 'elective on-pump' group (n=162) and 'conversion' group (n=54). The preoperative donor and recipient demographics and baseline characteristics and the postoperative outcomes were analyzed. 1:1 propensity score matching was used to identify patients operated upon using elective CPB who had risk profiles similar to those operated upon off-pump (Propensity matching 1) as well as those emergently converted from off-pump to CPB (Propensity matching 2). Results: Preoperative group demographic characteristics were comparable, however the 'off pump' patient group was significantly older. The 'conversion' group had a significantly greater number of patients with primary pulmonary hypertension, pulmonary fibrosis, preoperative mechanical ventilation and preoperative extracorporeal life support (ECLS). Postoperatively, patients from the 'conversion' group had significantly poorer PaO2 /FiO2 ratios upon arrival in ICU and at 24, 48 and 72 hours postoperatively, and they required more prolonged ventilation, longer ICU admission and they experienced an increased need for ECLS than the other groups. Overall cumulative survival at 1, 2 and 3 years was significantly worse in patients from the 'conversion' group compared to the 'off-pump' and 'elective on-pump' groups- 61.9% vs. 94.4% vs. 86.9%, 54.4% vs. 90.6% vs. 79.5% and 39.8% vs. 78.1% vs. 74.3% respectively (p<0.001). The 'off-pump' group had significantly better PaO2 /FiO2 ratios and a significantly shorter duration of ventilation, ICU stay and hospital length of stay when compared to the propensity matched 'elective on-pump' group. There were no statistically significant differences in postoperative outcomes and overall survival between the 'converted' group and the propensity-matched 'elective on-pump' group. Conclusions: After segregation of unplanned CPB conversion cases from elective on-pump cases, patients with comparable pre-operative demographic/risk profiles demonstrated better early post-operative outcomes and, possibly, an improved early survival with an off-pump strategy. A considerable proportion of high-risk patients require intraoperative conversion from off-pump to CPB and this seems associated with suboptimal outcomes, however there is no significant benefit to employing an elective on-pump strategy over emergent conversion in the high risk group. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2015 · Clinical Transplantation
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    ABSTRACT: Aim: We retrospectively analysed incisional hernia (IH) outcomes of liver transplant (LT) versus hepatopancreaticobiliary (HPB) cases sharing the same incision. Methods: IH repair patients with a history of LT were compared with those with HPB surgical history sharing the same type of incision and using the European Hernia Society classification and nomenclature for reporting outcome. Results: Eighty two patients (27 HPB and 55 LT) between February 2001 until February 2014 were analysed. Baseline demographics showed that the LT group had more diabetes and steroid use, but were less physical active. Outcomes showed no differences in wound complication, SSI rate and recurrence rate (recurrence rate of 11.1% and 16.4% for HPB and LT respectively). Multivariate analysis showed longer operating time to be a risk factor for both wound complication and SSI. M-tor inhibitor use was an additional risk factor for SSI. Interval to recurrence was significant longer in the LT group (35 versus 61 months). Cox analysis showed steroid use, immunosuppression and not using a synthetic mesh as risk factors for recurrence. Conclusion: Incisional hernia repair with synthetic mesh after liver transplantation does not result in more wound complications, SSI and recurrences when compared to patients without immunosuppression. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2015 · Clinical Transplantation

  • No preview · Article · May 2015 · Clinical Transplantation
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    ABSTRACT: With the increasing age of recipients undergoing orthotopic liver transplant (OLT), there is need for better risk stratification among them. Our study aims to identify predictors of poor outcome among OLT recipients ≥60 years of age. All patients who underwent OLT at Cleveland Clinic from January 2004 to April 2010 were included. Baseline patient characteristics and post-OLT outcomes (mortality, graft failure, length of stay, and major post-OLT cardiovascular events) were obtained from prospectively collected institutional registry. Among patients ≥60 years of age, multivariate regression modeling was performed to identify independent predictors of poor outcome. Of the 738 patients included, 223 (30.2%) were ≥ 60 years. Hepatic encephalopathy, platelet counts <45,000 /μL, total serum bilirubin >3.5 mg/dl and serum albumin <2.65 mg/dl- independently predicted poor short term outcomes. Presence of pre-OLT coronary artery disease and arrhythmia were independent predictors of poor long term outcomes. Cardiac causes represented the second most common cause of mortality among the elderly cohort. Despite that, this carefully selected cohort of older OLT recipients had outcomes, which were comparable with the younger recipients. Thus, our results show the need for better pre-OLT evaluation and optimization, and for closer post-OLT surveillance, of cardiovascular disease among the elderly.This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2015 · Clinical Transplantation

  • No preview · Article · Jan 2015 · Clinical Transplantation
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    ABSTRACT: Autoantibodies are frequently detected after liver transplantation (LT) but their role is unclear. The present study was designed to address 3 points: autoantibody prevalence pre LT and over time up to five years after LT, identification of possible predictors of autoantibody formation and correlation between autoantibodies and graft dysfunction. To these aims, we retrospectively evaluated 92 consecutive LT recipients for whom prospectively stored frozen sera were available for autoantibodies assessment by Immunofluorescence. The overall autoantibody prevalence resulted significantly higher after LT than before LT (64% vs 27%, p<0.001 and 35.9% vs. 8.7%, p<0.001 considering cut off titre of ≥1:80 and ≥1:160 respectively). Recipient gender, donor age and gender, indication for LT and main immunosuppressant (cyclosporine vs tacrolimus) were not associated to the presence of autoantibodies. Patients with graft dysfunction had a significantly higher autoantibody prevalence irrespective of the aethiology of liver injury as compared to those patients with persistently normal liver biochemistry, but only for cut off titres ≥1:160 (p= 0.004). No cases of "de novo" autoimmune hepatitis were observed. In conclusion, autoantibodies are very frequently detected after LT also at high titres and their association with graft dysfunction likely represents an aspecific indicator of liver injury. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2014 · Clinical Transplantation

  • No preview · Article · Dec 2014 · Clinical Transplantation
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    ABSTRACT: Preferences for the testing and treatment of antibody mediated rejection (AMR) in renal transplant patients varies amongst programs and individual practitioners. The description of these preferences and identification of commonalities can contribute to creating a standard of care. A survey was distributed through the Transplant Listserv of the American College of Clinical Pharmacy (ACCP) and via email to members of the American Society of Transplantation Community of Pharmacy (AST CoP), collected and analyzed. Most clinicians (26/28) test for donor specific antibodies (DSA) when evaluating a patient with possible AMR. Treatments for AMR varied widely amongst responding clinicians and included intravenous immune globulin (IVIG, n=25), plasmapheresis (n=24), rituximab (n=8), bortezomib (n=4), rabbit anti-thymocyte globulin (n=2), and eculizumab (n=1). Weight-based dosing of IVIG averaged 1.8 g/kg total dose. Six centers use rituximab as initial therapy, while 2 use rituximab if other therapy fails. Four centers use bortezomib as initial therapy, while 2 centers use it for severe/persistent AMR. One center uses eculizumab as initial therapy and one center uses it for severe AMR. Methods for the detection of antibody mediated rejection are similar, yet treatment of AMR varies widely. Most centers utilize DSA for detection and a combination of IVIG and plasmapheresis for treatment. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Nov 2014 · Clinical Transplantation
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    ABSTRACT: Background Autologous stem cell transplant (ASCT) is the current standard of care for most patients with multiple myeloma (MM) who are transplant eligible, yet the timing of ASCT is disputed due to a similar overall (OS) and progression-free survival with an early ASCT (eASCT) or a delayed ASCT (dASCT) approach.Objective We developed a decision analytic model to perform cost-effectiveness analysis of the two commonly used treatment strategies for MM.Methods Data on disease progression and treatment effectiveness came from 2001 to 2008 cohort treated at the Mayo Clinic and from published studies. Cost analysis was performed from a third-party payer perspective.ResultsThe Consumer Price Index adjusted 2012 costs of eASCT and dASCT were $249 236 and $262 610, respectively. eASCT cohort had a benefit of 1.96 quality-adjusted life years (QALYs), 0.23 QALYs more than dASCT, implying that eASCT is preferred (dominant) over dASCT. The most critical variables in one-way sensitivity analysis were treatment-related mortality and OS associated with eASCT strategy.Conclusions We conclude that eASCT could potentially be a relatively cost-effective treatment option for appropriate patients with MM, and these results would help patients, providers, and payers in decision making for timing of ASCT.
    No preview · Article · Aug 2014 · Clinical Transplantation
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    ABSTRACT: De novo malignancies are a main cause for late death after liver transplantation (LT). Everolimus (ERL) is an immunosuppressive agent with anti-tumoral properties. The aim of the present retrospective study was to identify prognostic factors, including conversion to ERL, for patients presenting non cutaneous de novo solid organ malignancy after LT for alcoholic cirrhosis. The study population consisted in 83 patients (presenting 100 tumours, including 75% of upper aero-digestive tract cancers), among the 398 patients who underwent LT for alcoholic cirrhosis in our centre. After diagnosis, ERL was introduced in 38 patients and calcineurin-inhibitor was discontinued in 64.1% of them. Tumour stage was a significant prognostic factor with a 1-year survival at 82.6% for early stages, 63.4% for intermediate stages (N+) and 27.4% for disseminated diseases (p<0.001). Associated relative risk factor was 2.202 (95%CI 1.044-4.644) for intermediate stages and 5.743 (95%CI 2.436-13.541) for metastatic stages. One and 5-year survival was 77.4% and 35.2% in ERL group vs. 47.2% and 19.4% in the non-ERL group, respectively (p=0.003). The relative risk factor for ERL was 0.447 (95%CI 0.257-0.778). Our results strongly suggest that conversion to ERL improves the prognosis of de novo malignancies after LT for alcoholic cirrhosis. Prospective studies are needed to confirm this benefit. This article is protected by copyright. All rights reserved.
    No preview · Article · Jul 2014 · Clinical Transplantation
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    ABSTRACT: Donor lymphocyte infusion (DLI) is often used to enhance the graft-versus-leukemia (GVL) effect after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this study, we first evaluated the impact of the cell composition of a modified DLI (mDLI) on the prognoses of patients. A total of 194 patients undergoing allo-HSCT were enrolled and received mDLI for various clinical reasons. The infused cellular components of the mDLI were examined by flow cytometry. The results showed that infusion with a lower dose of CD14+ cells (<0.33×10(8) /kg) was an independent risk factor for the occurrence of II-IV° acute graft-versus-host disease (aGVHD) (HR=0.104, P=0.032) in HLA-identical transplant patients. In addition, a dose of CD14+ cells greater than the 50(th) percentile was associated with a lower incidence of hematological relapse and longer disease-free survival (DFS) after the mDLI (relapse: HR=0.193, P=0.007; DFS: HR=0259, P=0.016). However, we also found that a greater number of CD14+ cells was an independent risk factor for II-IV° aGVHD (HR=1.758, P=0.034) in haploidentical allo-HSCT. In conclusion, our data were the first to demonstrate that the cell composition of a56 mDLI played a distinct role in different types of allo-HSCT. This finding provided a novel approach for the development of cellular therapies by manipulating the components of infused cells. This article is protected by copyright. All rights reserved.
    No preview · Article · Jun 2014 · Clinical Transplantation
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    ABSTRACT: Background: Concomitant administration of the triazole antifungals, voriconazole or itraconazole, with tacrolimus can result in significant drug interaction in the transplant recipient. Limited published information exists regarding tacrolimus dosing when transitioning from voriconazole to itraconazole. The objective of this study was to evaluate the extent of the drug interaction with antifungal prophylaxis using voriconazole followed by a change to itraconazole in lung transplant recipients receiving tacrolimus. Methods: This prospective study included lung transplant recipients receiving antifungal prophylaxis with voriconazole followed by a switch to itraconazole. Patients were followed from the time of transplant until two months after converting to itraconazole. All patients received standard immunosuppression with tacrolimus, mycophenolate mofetil, and a corticosteroid. Tacrolimus dose normalized concentrations using concentration/dose ratio were compared while receiving voriconazole versus itraconazole. Results: Twenty lung transplant recipients were included in the final analysis. No difference was found with the tacrolimus dose normalized concentrations on voriconazole 254 ± 28 (ng/mL)/(mg/kg) compared with itraconazole 234 ± 34 (ng/mL)/(mg/kg), p = 0.65. Conclusion: Tacrolimus dosage adjustments were not necessary when converting from voriconazole to itraconazole. Validation in a larger population is needed to confirm these findings.
    No preview · Article · Jun 2014 · Clinical Transplantation
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    ABSTRACT: Acute rejection remains a major cause for long-term kidney allograft failure. Reliable immunological parameters suitable to define the pre-transplant immune state and hence the individual risk for graft rejection are highly desired to preferably adapt the immunosuppressive regimen in advance. Donor- and 3(rd) -party alloreactivities were determined by mixed lymphocyte cultures. Soluble forms of CD25, CD30 and CD44 were detected in patients' serum by ELISA. Various lymphocyte subpopulations were measured using Flow-cytometry. All patients received triple immunosuppression (tacrolimus/mycophenolate mofetil/steroids) and were grouped according to biopsy results within the first year: rejection-free (RF, n=13), borderline (BL, n=5) or acute rejection (AR, n=7). Patients with AR showed the highest pre-transplant alloreactivities and serum levels (sCD25/sCD30/sCD44) according to the pattern RF<BL<AR. Relying on serum analysis only, multivariate logistic regression (logit link function) yielded a prognostic score for prediction of rejection with 75.0% sensitivity and 69.2% specificity. Patients with rejection showed markedly higher pre-transplant frequencies of CD4(+) /CD8(+) T-cells lacking CD28, but lower numbers of CD8(+) CD161(bright) T-cells and NK-cells than RF-individuals. Pre-transplant immune state defined by alloreactivity, serum markers and particular lymphocyte subsets seems to correlate with occurrence of graft rejection after kidney transplantation. A prognostic score based on pre-transplant serum levels has shown great potential for prediction of rejection episodes and should be further evaluated. This article is protected by copyright. All rights reserved.
    No preview · Article · Jun 2014 · Clinical Transplantation
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    ABSTRACT: Venous jump grafts are used in pancreas transplantation to salvage a pancreas with a short portal vein or to facilitate an easier anastomosis. There have been no large studies evaluating the safety of venous jump grafts in pancreas transplantation. We analyzed the UNOS database to determine whether venous jump grafts are associated with graft loss or patient death. Data from UNOS on all adult pancreas transplant recipients 1996-2012 were analyzed. Venous extension grafts were used in 2,657 cases; they were not in 18,124. Kaplan-Meier/Product-Limit Estimates analysis demonstrated similar patient survival (p<0.641) and death censored graft survival (p<0.351) at 1-,3-,5-,10- and 15-years between subjects with and without venous jump grafts. There was a statistically significant difference in 1-year unadjusted patient survival between the Venous Extension Graft (94.9%) and the No- Venous Extension Graft (95.8%) groups (p<0.045) and a borderline difference in 1-year graft survival between the Venous Extension Graft (84.1%) and the No- Venous Extension Graft (82.6%) groups (p<0.055). There was no significant difference in patient survival or allograft survival at the 3, 5, 10, and 15 year intervals. The use of venous jump grafts is not associated with increased graft loss or mortality. This article is protected by copyright. All rights reserved.
    No preview · Article · Jun 2014 · Clinical Transplantation
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    ABSTRACT: Kidney outcomes early post-liver transplantation (LT) are crucial for long-term prognosis, but difficult to predict. Among 203 adult LT patients, we studied the value of plasma neutrophil gelatinase-associated lipocalin (NGAL) measured pre-LT for predicting acute kidney injury (AKI), kidney-replacement therapy within 3 months, and kidney dysfunction at 3 months post-LT. Glomerular filtration rate (GFR) was estimated by creatinine-based and cystatin C-based equations. Highest NGAL levels were among patients on pre-LT kidney-replacement therapy, whereas NGAL exceeded 200μg/L in only 3 (2%) patients with pre-LT GFR >60mL/min. Pre-LT NGAL >260μg/L predicted GFR <60mL/min at 3 months post-LT (OR 17.8, 95%CI 2.1-153) independently of 19 other variables reflecting recipient characteristics, liver and kidney function, perioperative hemodynamic stress, and immunosuppression. Of 81 patients with pre-LT GFR <60mL/min, 48% had GFR <60mL/min at 3 months, and an NGAL level >260μg/L predicted this outcome with 90% specificity and 46% sensitivity. NGAL failed to predict post-LT AKI or need for temporary kidney-replacement therapy. In conclusion, NGAL independently predicted irreversibility of pre-LT kidney dysfunction and could thus help in optimizing patient care and in the decision to perform combined liver-kidney transplantation. Pre-LT NGAL was not useful in patients with preserved pre-LT kidney function or in predicting post-LT AKI. This article is protected by copyright. All rights reserved.
    No preview · Article · Jun 2014 · Clinical Transplantation